Managed Care Regional Director

Job Title

Managed Care Regional Director

Location

Virtual CA

Employee Type

Employee

Working Hours Per Week

40

Summary

The Managed Care Regional Director will be responsible for evaluating, negotiating, credentialing, and securing financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations. 

​Salary Range: $150,000 - $180,000/yr (DOE)

Schedule: (Remote) Monday - Friday, 8:30am - 5:00pm PST

Location: Virtual CA

Travel: This position is expected to travel up to 25 - 30% for various conferences, sales meetings, etc. with the longest being 4 weekdays at a time

Essential Duties and Responsibilities

include the following. Other duties may be assigned, as necessary.

• Leads the implementation of managed care contracts and develops and maintains systems to effectively disseminate contract information for the assigned region.
• Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
• Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payers and providers 
• Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations
• Responsible for coordination and communication between managed care and other interested party departments and leadership
• Responsible for developing new and existing relationships with medical and pharmacy plans to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
• Oversight of payer credentialing
• Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
• Communicates with respective payers related to trends and compliance with contract parameters
• Consistently represents the company in a professional manner
• Maintain effective working relationships and cooperate with all personnel in the Company
• Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies
• Perform other duties and responsibilities as assigned

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations regarding Managed Care contracts
• Provide the highest level of professionalism, responsiveness, and communication in order to build and maintain the maximum customer base possible
• Must possess the ability to multi-task and frequently change direction

Education and/or Experience

• Bachelor’s Degree preferred or equivalent experience 
• ​At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry 
• ​Minimum two years in healthcare management manage care environment and administering contracts or equivalent experience 
• ​Preferred experience in managing, analyzing, and reporting denials and appeals.​ 

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or listen. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

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CSI Pharmacy is an Equal Opportunity Employer